An Editorial in this week’s medical journal The Lancet on home births says that while a woman has the right to choose where and how to give birth, she does not have the right to put her baby at risk.

The Editorial reveals that in The Netherlands approximately one third of all births occur at home. In the United Kingdom 3% and the USA 1% (25,000) of babies are born at home. The demand for giving birth outside a hospital setting is growing.

Home births for low-risk mothers (compared to hospital deliveries) are linked to:

  • Faster recovery times
  • Fewer lacerations
  • Fewer post-partum hemorrhages
  • Fewer infections
  • Lower risk of retained placentae

However, the outcomes for newborn babies delivered in hospital are better, when compared to home births.

The Editorial says that recent meta-analysis published in the American Journal of Obstetrics & Gynecology “provides the strongest evidence so far that home birth can, after all, be harmful to newborn babies”. The data show that planned home births to healthy and low-risk mothers compared with planned hospital births in the same group of women doubled the risk of neonatal deaths (0•2% vs 0•09%). And when infants with congenital defects were excluded, the risk of neonatal mortality tripled. The main attributable factors for the increase in mortality were the occurrence of breathing difficulties and failed attempts at resuscitation – two factors associated with poor midwife training and a lack of access to hospital equipment.

The Editorial concludes:

Home delivery is an option for mothers with uncomplicated pregnancies, provided they are advised of the risks involved, have one-to-one midwife care (that includes good resuscitation skills and accreditation by a local regulatory body), and live in a location that allows quick access to obstetric care. The ongoing multiyear cohort study, Birthplace in England Research Programme, aims to compare birth outcomes in different settings, and the results are expected to provide additional valuable data later this year.

“Home birth – proceed with caution”
The Lancet, Volume 376, Issue 9738, Page 303, 31 July 2010

Written by Christian Nordqvist